公立医院产权制度改制程序研究

在我国大部分地区,公立医疗机构产权改革是在当地政府领导下,仿照国有企业的产权改革程序进行.但是,在公立医疗机构的托管制改革中,还没有专门的程序可以遵循.地方卫生行政部门通常掌管着医疗机构委托管理的改革过程.     

公立医院产权改革中相关问题的处置及改革风险分析

资产(固定资产、无形资产和土地)、公共卫生服务和人员问题是公立医疗机构产权改革中必须予以认真关注的3个主要问题.同时,公立医疗机构产权改革还必须面对国有资产流失、卫生资源流失、政府控制减弱的风险,以及投资和运营风险.     

我国公立医疗机构产权制度缺陷分析

产权是所有制的核心和主要内容,公立医疗机构固有的一些弊端没有得到根本消关键在于目前公立医疗机构的产权制度存在重大缺陷.该文主要根据产权经济学的有关理论,对目前公立医疗机构的产权主体、产权结构、产权的交易性、产权中使用权和终极所有权关系等情况及由此产生的一些问题进行分析.     

公立医院产权改革研究综述

从上世纪80年代开始,国内出现了关于公立医院产权问题的研究.院长负责制是公立医院产权改革的开始.到上世纪90年代,来自海外以及其他行业的关于产权改革的理论和实践开始被引进到我国公立医疗机构的产权改革中.     

公立医疗机构改制的形式

公立医疗机构改制是医疗机构管理体制改革中的重要环节,本文在文献归纳的基础上讨论了公立医疗机构产权改革的形式--债权法、股权法和拍卖法,并列举了改制过程中的几种融资渠道,阐述了改制中应予以重视的问题.     

关于公立医院"两权分离"改革方案制订要点的探讨

城镇和农村公立医疗机构实行经营权和所有权适当分离的改革,是扩大公立医疗机构自主权,建立起产权明晰、权责明确、自我约束、管理科学的公立医疗机构运行机制的有效途径,应加快这一改革推进的速度和力度.在这一改革中,卫生主管部门尤其是县(市)级卫生主管部门对每个进行改革的公立医疗机构应制订科学、合理的方案.该方案应包括该医疗机构经营权的实现形式、经营者的确定方式、改革进度安排、经营者经营期间的目标(责任)和权利等内容,笔者认为,对于改革方案的制订应掌握以下几个要点.     

我国公立医疗机构民营化的政策选择分析

文章以民营化作为我国公立医疗机构改革的政策选择，在给予其合法性分析的基础上．进而指出可以以，公立医疗机构的产权革新和公共民营合作制的非产权变动作为进入路径，来突破政府对医疗保健服务的行业垄断和医疗服务供给体系的歧视性安排．重构医疗保健服务制度体系。     

对医疗机构产权改革的思考

中国医疗机构的产权改革曾经是医疗改革的焦点问题，特别是围绕公立医疗机构产权的股份化，有各种截然不同的看法。但是，观察国外医疗机构的产权结构及其发展，我们看到产权并非造成医疗成本高或服务质量低等问题的根源，结果可能恰恰相反。关键问题在于国家是否有合适的医疗保障计划和与之相匹配的医疗服务供应体系。通过介绍国外医疗机构的产权状况，结合我国实际情况加以比较，使我们从中得到有益的启示。     

我们该向国外医院法人治理结构学些什么？

公立医疗机构改革涉及付费,服务内容等多方面的内容,但最终方向应是建立法人制度。在法人制的大框架下,卫生行政主管部门依法行使医疗卫生行政监督职能,对公立医疗机构的人、财、物职能予以剥离,实现“政事分离”。依照“政事分离”的原则,现行的卫生行政主管部门应当将公立医疗机构的人财物全部剥离给国有资产管理部门。     

浅谈卫生行政部门对公立医疗机构的监管

以提高公立医疗机构的服务质量为主旨,对当前医疗机构服务状况给公众、卫生行政部门带来的压力进行阐述与分析,指出加强对医疗服务机构监管的必要性.同时,针对卫生行政部门对公立医疗机构监管存在的障碍,提出通过对公立医疗机构国有资产监管工作的重置或转移,实现卫生行政部门与公立医疗机构的管办分离.     

Resources and capacity of emergency trauma care services in Peru

The objectives of this study were to evaluate the resources and capacity of emergency trauma care services in three Peruvian cities using the WHO report Guidelines for Essential Trauma Care. This was a cross-sectional study in eight public and private healthcare facilities in Lima, Ayacucho, and Pucallpa. Semi-structured questionnaires were applied to the heads of emergency departments with managerial responsibility for resources and capabilities. Considering the profiles and volume of care in each emergency service, most respondents in all three cities classified their currently available resources as inadequate. Comparison of the health facilities showed a shortage in public services and in the provinces (Ayacucho and Pucallpa). There was a widespread perception that both human and physical resources were insufficient, especially in public healthcare facilities and in the provinces.     

Private sector health services use in the Omsk region

The progress made by the private medical sector in different Russia's regions has been uneven. A key share of private medical facilities is concentrated in big cities. The frequency rate of citizens' asking the rural and urban private practitioners for medical care was investigated by the example of the Omsk Region. The dynamic morbidity and the specificity of its structure are described on the basis of the data contained in basic medical registration documents borrowed from private medical institutions. The importance and value of the information-and-analytical cooperation between the private-sector structures, on the one hand, and the healthcare management bodies, on the other hand, are pointed out.     

Health technology assessment in Belgium

The Belgian healthcare system has a Bismarck-type compulsory health insurance, covering almost the entire population, combined with private provision of care. Providers are public health services, independent pharmacists, independent ambulatory care professionals, and hospitals and geriatric care facilities. Healthcare responsibilities are shared between the national Ministries of Public Health and Social Affairs, and the Dutch-, French-, and German-speaking Community Ministries of Health. The national ministries are responsible for sickness and disability insurance, financing, determination of accreditation criteria for hospitals and heavy medical care units, and construction of new hospitals. The six sickness and disability insurance funds are responsible for reimbursing health service benefits and paying disability benefits. The system's strength is that care is highly accessible and responsive to patients. However, the healthcare system's size remained relatively uncontrolled until recently, there is an excess supply of certain types of care, and there is a large number of small hospitals. The national government created a legal framework to modernize the insurance system to control budgetary deficits. Measures for reducing healthcare expenditures include regulating healthcare supply, healthcare evaluation, medical practice organization, and hospital budgets. The need to control healthcare facilities and quality of care in hospitals led to formal procedures for opening hospitals, acquiring expensive medical equipment, and developing highly specialized services. Reforms in payment and regulation are being considered. Health technology assessment (HTA) has played little part in the reforms so far. Belgium has no formal national program for HTA. The future of HTA in Belgium depends on a changing perception by providers and policy makers that health care needs a stronger scientific base.     

Effects of decentralisation and health system reform on health workforce and quality‐of‐care in Indonesia, 1993–2007

The impact of decentralisation, socioeconomic changes and healthcare reforms in Indonesia on type and distribution of healthcare providers and quality‐of‐care has been unclear. We examined workforce trends for healthcare facilities from 1993 to 2007 using the Indonesian Family Life Surveys. Each included a sample of public and private healthcare facilities, used standardised interviews for numbers and composition of staffing, and quality‐of‐care vignettes. There was an increase in multiprovider facilities and shift in profile of solo providers—increasing proportions of midwives and drop in doctors in rural areas (including facilities with doctors) and nurses in urban areas. Quality‐of‐care scores were low, particularly for nurses as solo providers. Despite increased numbers of healthcare workers and growth of the private sector, outer Java‐Bali and rural areas continued to be disadvantaged in workforce capacity and quality‐of‐care. The results have implications for accreditation and in‐service training requirements, the legal status of nurses and private sector regulation. Copyright © 2014 John Wiley & Sons, Ltd.     

托幼机构卫生保健服务资源现状调查分析

目的了解福田辖区托幼机构卫生保健服务资源基本情况,提出相应的对策和建议,为进一步做好托幼机构儿童卫生保健管理工作提供参考。方法通过发放“托幼机构基本情况调查表”,掌握福田辖区托幼机构卫生保健服务资源基本情况。结果本次调查的91家托幼机构中私立幼儿园占72.53%;取得“卫生保健合格证”的占87.91%;使用儿童保健管理软件的占30.77%;配备专职保健医生的占73.63%。被调查单位均设置有保健室,保健医生共93人,其中年龄段为20～39岁的占78.49%;医疗专业占41.94%,护理专业占7.63%,妇幼保健专业占17.20%;专科学历占95.70%,本科学历占4.30%;初级技术职称占90.32%,中级以上技术职称仅占7.53%人。结论托幼机构卫生保健服务资源配置仍存在一定的问题,如无证办学现象仍然存在,人员素质普遍偏低,人才队伍不够稳定,信息化建设滞后等。卫生主管部门应加大监管、督导和培训力度,合理配置资源,不断提高托幼机构卫生保健服务水平,保障儿童的健康成长。     

公立医院开展慈善工作的意义及建议

随着医药卫生体制改革的深入,医疗行业也越来越注重公益慈善工作,公立医院通过慈善救助践行着公益宗旨,对医改的推进及构建和谐社会都具有重要意义。本文通过分析公立医院医疗慈善救助的设立和模式,对医疗慈善救助基金体系的完善提出建议。     

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

Background:

The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores.

Materials and Methods:

This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1^st Jan 2014 to 1^st July 2014 was taken for deciding their efficiency scores.

Results:

The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001).

Conclusions:

The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future.     

Making their voices clearly heard. Investor-owned facilities are working hard to share their opinions on healthcare reform

For-profit facilities are reaching out into their communities in efforts to share their views on healthcare reform and forge stronger ties with local business groups and governments. Because healthcare reform is drawing more interest than ever, their executives believe it's crucial to voice concerns about any legislative action that may affect their facilities' bottom line.     

Objectively measured access to recreational destinations and leisure-time physical activity: Associations and demographic moderators in a six-country study

Within the growing body of research linking neighbourhood environmental attributes with physical activity, associations between recreational destinations and non-walking leisure-time physical activity (LTPA) are rarely studied, and to date, not across multiple cities. We examined six potential associations of objectively-measured access to private recreational facilities (e.g., fitness centres, swimming pools) and parks with adults’ non-walking LTPA (e.g., swimming, cycling, tennis), using data gathered with consistent methods from adults living in international cities with a range of environment attributes. The potential effects of socio-demographic moderators and between-city variations were also examined. Data from 6725 adults from 10 cities (6 countries) were gathered. Adults were more likely to engage in non-walking LTPA if they had a greater number of private recreational facilities within 0.5 or 1 km of the home, particularly in women, and if they lived closer to a park. The amount of non-zero LTPA was only associated (positively) with the number of recreational facilities within 1 km. Relationships between amount of LTPA and park proximity appear complex, with likely contextual and cultural differences. Improving access to private recreational facilities could promote non-walking LTPA, especially in women.